NewPublicHealth Q&A: Paul Jarris of ASTHO

Paul Jarris, M.D., Executive Director, Association of State and Territorial Health Officers (ASTHO), moderated a panel on workforce issues at the recent American Public Health Association Midyear meeting. NewPublicHealth asked Dr. Jarris about some of the key workforce issues confronting public health right now.

NewPublicHealth: What are some major issues that the public health workforce is currently dealing with?

Paul Jarris: It’s a very interesting time because on the one hand we’re looking at how we develop a pipeline, particularly for people who are ethnic or racial minorities, so that they can enter the public health workforce. Like all areas, the public health workforce needs to represent the people we’re serving--and for the first time ever, we have more babies being born of color than there are Caucasian babies being born and so we will have to build a workforce to reflect the fact that we are a minority-majority country in many ways now. So the pipeline issues clearly are there.

But the other issue that’s quite acute at this time is that we are eliminating vast numbers of public health jobs. Between ASTHO and NACCHO (National Association of County and City Health Officials), we estimate that we’ve lost at least 43,000 public health workers at the state and local level--and that was before the 2011 Federal cuts. So that number is going to escalate dramatically. It also doesn’t include the furloughs that are happening in many states. So we’re looking at how do we bring the appropriate people in--and at the same time we’re dealing with the practical issues of how do we lay people off and how do we furlough them?

So it’s a very interesting time and a confusing time. But what we do know is that in the future governmental public health will look different, and it will do different things than what it’s doing today and we’ll have to have different skills and a different type of public health worker to reflect the population we’re serving.

NPH: Do you think that the need for a different public health work force might speed up the loss of older workers who actually have a strong skill set?

Paul Jarris: We certainly are seeing that. And one of the techniques being used in the private sector is early retirement. We are seeing very good people step forward and wave their hand to say, ‘I’m ready--I want to retire.’ So we are concerned about attrition. Fortunately, the attrition picture of older workers is not as bad as we projected. Because of the economy people are actually staying in the workforce because they’re worried about jumping off and not finding a job elsewhere. But clearly, we will see more of the public health workforce retiring.

NPH: Can you talk about the workforce report released by the APHA during the meeting? The report found the while the Patient Protection and Affordable Care Act reauthorized and created several programs that could increase the supply and expertise of the public health workforce, so far only 11 of 19 provisions reviewed in the report have received funding. And those that have received monies have been funded at substantially lower levels than authorized.

Paul Jarris: What we’re seeing is dramatic reductions in government because of the economy and because of the political atmosphere we’re in. So we have seen dramatic reductions in the WIC program, which is where we employ most of our public health nurses. We’re seeing 12 percent cuts in the public health preparedness program and 10 percent cuts in the hospital preparedness program. Those are the things that allowed us to build and expand our epidemiological workforce. So what we’re seeing is program after program being cut. As a result of some of these cuts, we’re losing fundamental public health capacities that are necessary to support new programs, like community transformation grants.

NPH: Do you think increasing the number of Bachelor of Science programs in Public health would help to get younger people interested in this field?

Paul Jarris: I know that the public health academic community is looking at this issue. Where would more Bachelor graduates of public health fit in the work place and what does that mean for Masters Programs in public health? How will they now distinguish themselves from a high performing bachelor? So it’s a very interesting question for me. It’s a very hopeful thing because by allowing people to come in at a bachelor’s level--I think there will be more opportunities for us in public health to hire more qualified people. For example the model of talking a Masters in Public health and trying to train them to be an informatics specialist is a real long-shot as opposed to taking someone who has studied informatics at the bachelor’s level and has a double major in public health. I would hire that person in a heartbeat because they know public health and they have grounding in informatics. Most of the workforce in state and local public health is not Masters of public health, but they’re a niche within the public health workforce. In local public health, a large percentage of the workforce doesn’t even have a bachelor’s degree. So looking at the Associates degree is critical. What we need is more programs at the Associates level, the Bachelors level, the Masters level--so we have that pipeline. That will also be important for people who come from less advantaged backgrounds or people of color or others who are the first person in their family to go to college. They can start at an Associates level and work their way up to a Bachelors and then work up to a Masters. So we have lowered the threshold in a sense for people entering the public health field.

NPH: What are some of the different skill sets that people need in the public health workforce?

Paul Jarris: We are already seeing local health departments start to deliberately transform themselves from being direct service providers into providers of population health. And one department close to here--in Kane County, Illinois--actually used the public health accreditation standards to redefine the roles of their department. Rather than providing a direct service such as a clinical service, they will actually be out there looking at the issues of the built environment and how they can impact food deserts or how they can impact playground safety or the ability for kids to walk to school.

So moving towards that population level means understanding public policy, understanding private policy, understanding how to impact the environmental factors affecting health-which would mean working with parks and recreation, working with zoning, city planners--and it would also mean affecting people’s social norms. How do we actually change the perception of what is normal like we did with tobacco where it is no longer considered to be a natural thing for people to smoke cigarettes? How will we be able to affect people’s notion on what is a normal body mass index? Or what is the normal amount of exercise to get? What is the normal portion size to eat?

So the public health work of the future will have to understand that population basis. The other important thing as we look at future support and impact of public health--it’s clear that we need to not be doing more clinical services, but be more integrated with the clinical sector. So the question becomes: what is population health and how does public health interface with the clinical sector so we can impact health outside the walls of the clinical exam or hospital? And it will take a public health workforce who not only knows public health and the tools of it but is fluent in clinical medicine. We probably don’t have enough of those people right now working for us.

And I truly do believe public health is going to have to lead the clinical sector and how we address the social determinants of health and the things that are driving inequities-racial, ethnic, economic, geographic disparities in this country.

This commentary originally appeared on the RWJF New Public Health blog.

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